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One of the biggest challenges the oncology industry faces is getting treatment and medicine to the patients that need it. Many people suffering from cancer live in underserved areas, which can make it difficult to even get a diagnosis. Chitkala Kalidas, vice president and global head, Bayer Oncology Regulatory Affairs and Oncology Sustainability, spoke with Pharm Exec about her efforts to bring equity to these patients and underserved communities through her company’s Oncology Sustainability Initiative.
Pharm Exec: What are the main obstacles preventing patients from getting the treatments they need?
Kalidas: I would say the top three factors are geography, the economic situation, and infrastructure. If you overlay a lack of awareness in some communities, that can also compound the issue. People don’t really think about cancer right away; they have other problems to deal with daily. For them to get to the answer “could this be because of cancer” doesn’t really happen naturally in some of these communities.
Pharm Exec: What are the best ways to get treatment and medicines to underserved communities?
Kalidas: The communities we have targeted are underserved communities in middle- and low-income countries, sometimes even underserved communities in the US, for example, typically rural communities. We came to focus on—especially in countries outside the US, which is where we started with our BETA initiative—capacity building as being extremely important. That lays the foundation for bringing quality cancer care to patients and to reduce these disparities. When we say capacity building, we focus on working with physicians to understand what their needs are, how to standardize methods for diagnosing, testing, and screening for disease. We invest in those basic capabilities in specific countries before we even grow into the space of treatment.
If I take our project in India, for example, the infrastructure is present, but you need to make the right connections between the primary and secondary health centers which are in the rural communities. They don’t necessarily focus on cancer, but getting them in touch with the tertiary centers would be very important. Those are the multispecialty centers that may be focused on cancer. Building those connections between primary, secondary, and tertiary institutions and doing cancer screening in that situation makes sense, because there are options for patients who if they were to get screened and are positive for cancer, they will get reimbursed for their treatment because the government has an insurance policy in place where they can get that coverage.
We are very focused on making sure that we do not leave patients stranded with bad news. If there are no means of patients getting quality treatment—either because the products aren’t available or the products are available but there is no way for them to get covered under a public scheme or any insurance scheme—then we don’t want to go right away into screening. If we screen but they still can’t get the treatment, there is no improvement on outcomes. There, we focus on basic capacity building. Then you also engage the authorities at the ministry of health and advocate for the coverage for the appropriate treatment. We do this without being focused on any one drug. We are really looking to build the infrastructure or partner with organizations that contribute to building the infrastructure.
There are countries like Egypt where we partner with the ministry of health. The appropriate products may be available, but still the local outcomes are not close to the real global outcomes. We try to invest on capacity building but also disease awareness screenings to make sure that the right patients get the right treatment at the right time so that they do not present very late when there are no curative options. These are the types of projects that we’ve been active in, and we believe these are the ways to bring these medicines to these patients in these underserved communities.
Pharm Exec: What challenges have you faced bringing these programs to underserved areas?
Kalidas: The first problem is a lack of infrastructure. If there isn’t an infrastructure, even if we or other companies were to have the drugs, there’s no way they could reach the patient. If the economic situation is a big issue, so there is no way for patients or governments to pay for treatment, that can also be a problem, because we want to have sustainable solutions for these patients.
Of course, there are donation programs, and Bayer supports several patient-assistance programs. As part of Bayer’s Oncology Sustainability Initiative, one of our key goals is to create solutions that continue to exist as a sustainable, long-term solution for the community, so that when the project stops, that benefit doesn’t disappear for the community. We want it to keep on going. That’s why with these projects we are targeting to integrate these initiatives, outreach activities, and cancer-screening activities. All of these will be integrated in the community so that it continues even after the project is over. Those are some of the obstacles we see, and that’s how we’re trying to address them.
Pharm Exec: What is the primary issue causing these disparities?
Kalidas: I would say that it’s an economic issue, primarily, which gets compounded by several other factors. That’s why we are going in with the help of governments to address these issues.
Pharm Exec: What are the next steps for reducing disparities in cancer treatments?
Kalidas: The next steps are these kinds of efforts gaining traction and targeting additional communities around the globe. That is our goal; not just to stay limited to the three communities that we currently have. We have ambitions of reaching communities as large as 300 million people around the globe by 2030.
We believe that we can do this through public/private partnerships and truly engaging the leaders in the communities. Local leaders have a part to play. We have a part to play. Multiple stakeholders—the ministry of health responsible for these communities—all have a part to play, so that’s why Bayer sees itself as a member of this ecosystem that is focused on creating equitable models of cancer care that are also sustainable for the community. We’re very excited about these projects, we truly believe in them, and we’re excited about expanding them to other geographies and additional communities within the countries where we’re already active.
We are continuously adding new territories to our initiative. We started with India first, then added Egypt, and then Ghana. We’ve only started this project over the past 12 months, so we’re very happy to have these three projects underway, but we expect to add more. We’re also planning to initiate such projects within the US as well, targeting underserved communities, rural communities within the US that have similar issues as some of these communities outside the US.